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116 Cards in this Set
- Front
- Back
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In a CPS reportable incident what age must the victim be? What age must the perpetrator be?
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victim is under age 18. Perpetrator is any age.
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What 4 types of events are reportable to CPS?
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if your minor client is involved in:
- non-accidental physical injury (does not include "affrays between minors"), - sexual abuse (includes sexual assault and sexual exploitation), - willful cruelty or unjustifiable punishment (includes mental suffering), - neglect by person responsible for child's welfare |
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What constitutes sexual abuse?
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sexual assault and sexual exploitation (anything relating to pornography)
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At what age/ages (for both partners) is non-consensual sex reportable for minors?
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All ages - you always have to report nonconsensual sex involving a minor client.
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Do you need to report your client's 14 or 15 year old client's consensual sex, with a similar aged partner?
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not reportable, unless there is abuse
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7 factors that must be considered to determine if sexual intimacies are ethical even after the 2 year moratorium
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1)amount of time since termination, 2) the nature, duration and intensity of the therapy, 3) the circumstances of the termination, 4) the ct's personal history, 5) the ct's current mental status, 6) the likelihood of adverse impact on the ct, and 7) any invitation by therapist during therapy suggesting/inviting a posttermination sexual/romantic relationship with ct
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3 situations where the psychologist is required to terminate therapy
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it is reasonably clear that:
the ct no longer needs the service, or the ct is not likely to benefit, or the ct is being harmed by continued service |
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when can a psychologist do uninvited in-person solicitation of business from persons who may be vulnerable to undue influence?
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1. collateral treatment to benefit existing ct (w/client's permission so confidentiality isn't breached)
2. disaster services 3. community outreach (example is for older adults who the psych field feels do not spontaneously self-refer) Can educate about benefits of mental health intervention and encourage them to seek help |
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How long does HIPAA say you need to retain records?
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6 years from the date of its creation or the
date when it last was in effect, whichever is later. |
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Can psychotherapy or personal notes be subpoenaed?
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no
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What are APA guidelines for keeping records?
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complete records for a minimum of 3 years after the last contact with the ct, and a summary for an ADDITIONAL 12 years. If ct is a minor, either this or 3 years after the age of majority
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Under FERPA, parents can inspect a student's education records. what about the records of a school psychologist?
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If kept in the sole possession of the psychologist, used only as a personal memory aid and not accessible or reavealed to any other person except a temporary substitute for the psychologist, they are NOT part of the record and so are not subject to parental inspection
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The psychologist does not accept email from cts, or use her computer in any way related to her practice. Does she ever need to be HIPAA compliant?
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If any entity acting on her behalf (such as a bill paying agency, insurance company or HMO) has electronically stored or transmitted PHI related to any ct in the practice, HIPAA applies.
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Can psychologists withhold records under their control for nonpayment even if requested by the ct?
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yes, but only if not under HIPAA, and the situation is not an emergency. HIPAA does not distinguish between emergency and nonemergency requests, nor does it consider failure to pay as a legitmate reason to refuse a request to release records.
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A client requests a list of entities to whom the psychologist has release client's PHI, for the last 4 years. Can the psychologist charge a fee?
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Not if this is the first request in the past year. Each year, clients receive one free accounting of all disclosures during the past six years.
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If you intend to use collection agencies to collect debts, what must you do?
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1. Inform clients during informed consent procedures, that this is a possibility.
2. Inform the individual that you are about to use one to collect a debt, and give the person the opportunity to pay it first. (Should be at least 60 or 90 days after payment would normally be due.) |
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Under what conditions can you barter?
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If it is not clinically contraindicated and if the resulting arrangement is not exploitative. Problem is possiblity of harmful dual relationships or loss of professional objectivity
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when does HIPAA permit authorization for use/disclosure of PHI to be combined with informed consent information?
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Research activities (see Fisher p 149). Under HIPAA, during research, you can also refuse treatment if the individual refused to sign the authorization to use/release PHI for the research project.
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What is the "therapeutic misconception" and how do you handle it?
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This is the idea that "experimental" treatment means "better" treatment with known direct benefits. During informed consent procedures for research investigating new types of interventions you have to clarify that this tx is untested, may involve risks, etc., whatever is true.
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when can you record research participants without their consent?
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-observations are in a public setting where you would not expect to have privacy
- procedures do not disturb the natural surroundings, AND - participants are protected against personal identification and harm OR if you are doing deception research, with the prior approval of the IRB (and then must get consent during debriefing or destroy the recording) |
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what special steps are needed when a psychologist conducts research with cts, students or subordinates as participants?
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Must take steps to protect the prospective applicants from adverse consequences of declining or withdrawing such as NOT doing the informed consent process yourself or not having any research procedures that involve direct contact with the individuals. Par's must know that refusal/withdrawal will not affect services, grades, performance evals, privileges, etc.
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to whom does the APA ethics code apply?
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APA members
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What are the statute of limitations for ethics complaints to the APA?
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member of the public - 5 years
APA member - 3 years |
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What is confidentiality?
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An ethical concept that has legal consequences related to maintaining the privacy and integrity of information given to a psychologist in our professional role
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What determines if a contact is "professional" in the context of confidentiality?
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The intent of the parties, and the context of the exchange (in or out of office, on personal or private line, etc.)
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when can psychologists break confidentiality?
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I. Permissive Exceptions
- clt gives permission - ct is danger to self II. Mandated Exceptions - child abuse reporting - elder/dependent adult abuse reporting - court ordered - Tarasoff situation (danger to others) |
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If client is in danger of suicide is there a duty to report?
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not legally. maybe ethically if can't manage it in professional confidential context.
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significance of Ewing vs. Goldstein?
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extends Tarasoff requirements to family members who tell psychologist that his client is going to harm others, IF it is done "to further treatment" (i.e., aren't telling to get back at client)
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Can friends or domestic partners trigger Tarasoff warning?
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not according to law. must be family members or client himself.
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Under which do clients have more access to their records: APA Ethics Code or HIPAA?
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HIPAA
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What are important concepts that make up informed consent?
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Tx must be voluntary (except minors, mandated by courts, police or military e'ees, etc)
Ct must be legally competent Ct must be informed about tx (see separate question about what constitutes "informed") |
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What are the things that must be included for information about treatment for ct to be "informed"?
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-the nature and purpose of the service (length of sessions, duration of tx, goals of tx, individual/group, homework, talk therapy, etc.)
-the potential risks & benefits of tx -methods used This must ALL be in understandable language. Should also include info re $ esp limitations associated w/3rd party payments |
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What kind of grievance procedures are necessary for private practitioners?
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If under HIPAA, must give info on how to file complaints under HIPAA. In CA, must give contact info for complaints to Board of Psychology
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Does consent always have to be given in writing?
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No, if situation demands it, consent can be brief, and verbal, but you should document it, and get written consent as soon as practical.
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What are the 3 exceptions to an assessment client's right to an explanation of the nature and purpose of the assessment?
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They are job applicants where testing is standard, or it's standard educational testing, OR if testing is for determining decisional capacity (i.e., Alzheimer's type cognitive effects - but still need to do best to explain what is happening)
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Assessment clients have right to know test results and appropriate interpretation of them? T/F
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true, unless told ahead of time that this will not be possible
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Psychologists must release the raw data to clients and client's designees if requested. T/F
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true, but must also maintain the integrity of the test materials.
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Psychologists can publish their own tests for others to use. T/F
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true, IF they give data re: reliability, validity, stats on normed populations, administration info, interpretation info
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In CA, the WISC (and other cognitive ability tests) can be used for educational placement decisions. T/F
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T, except for African Americans, because of the Larry P. decision that stated that the WISC discriminates against them.
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When are multiple relationships permitted?
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If there is no risk of exploitation or harm to the client, and psychologist won't lose professional objectivity, and won't impair professional effectiveness
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when can Jane Professor have sexual intimacies with Joe College?
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When they are in different departments/schools, and the professor has no/will never have any evaluative or direct authority over Joe
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How is competency developed in any particular area of practice?
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Education and supervised experience
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Psychologist maintain scientific and educational knowledge about their areas of practice solely because of state CEU requirements. T/F
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False. We are ethically mandated to maintain our skills and knowledge.
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Psychologists are ethically mandated to charge all the clients the same rate. T/F
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F. you can have a sliding scale
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Under HIPAA, when can a covered entity decline to release PHI?
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Only if it is reasonably likely to endanger the life or physical safety of the individual or another person, or is likely to cause equally substantial harm. the psychologist must allow the ct to have the denial reviewed by a designated licensed health care professional, if desired.
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What is the Tarasoff rationale?
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the client's privacy ends where public peril begins, so you must contact the intended victim and police, in an attempt to protect the victim (NOT just a duty to warn, but also a duty to protect)
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What 4 things do you need to have established to make a Tarasoff report?
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1. Someone who has made a threat (your client)
2. An intended and identifiable victim 3. The nature of the threat 4. Facts that make the threat "Serious" such as a plan, a proposed method, hx of violence, intensity and veracity of the threat |
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When might you do a 5150 instead of a Tarasoff?
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When you can't adequately identify the victim, but you believe the harm will occur.
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What should you do if your HIV-positive client is having unprotected sex?
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Can't breach confidentiality even if you know the name of the partner. should counsel clt on safe sex practicies. Should work w/ct re why NOT practicing safe sex.
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Is punishing a child by hitting her with a belt reportable to CPS?
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Depends. If there was blistering or bruising, yes. If hit w/the belt buckle, yes. You can also consult w/CPS if you are in doubt.
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To make a CA CPS report do you have to be absolutely sure something happened or just have a reasonable suspicion?
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Reasonable suspicion - average professional in same position would have an objectively reasonable suspicion based on their education and training that abuse has occured. Must report even if no signs of abuse, if you have reasonable suspicion.
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In CA, if your 16 year old client reports that s/he has had consensual sexual intercourse with a 21 year old partner, do you report it?
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no
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In CA, if your 15 year old client reports s/he has had consensual sexual intercourse with a 21 year old partner, do you report it?
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YES. 21 is the cut off for sex with persons under 16 years of age. IF 20, definitely not. If 21, definitely do report.
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Do you report to CPS if your client is under 14 and the partner is also under 14, and the sex is consensual, and they are similar chronological or maturational age?
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no
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do you make a CPS report if your client is 13 and the partner is 14?
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yes
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If your 16 year old client has consensual sex with a 16 year old sibling is it reportable?
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yes. incest is always reportable.
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If a 70 year old client's friend tells you that the client is being physically abused by a caregiver and you believe it, do you report it?
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yes. If you have reasonable suspicion of abuse, the information can come from any third party.
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Regarding elders, do you report neglect and financial abuse?
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you must report it according to section 15630 (b), in addition to physical abuse, abandonment, abduction, and isolation, if you are a mandated reporter.
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What types of elder abuse MUST you report?
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physical, sexual, abandonment, isolation, any treatment resulting in physical harm or pain or mental suffering, over or under use of medication, insufficient food or shelter, financial abuse, abduction, physical or chemical restraint for punishment or unauthorized by a MD.
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physical abuse (includes sexual abuse, constraint, lack of food and water, meds), abandonment,abduction, isolation, financial abuse, or neglect (self care, personal hygiene, medical care, malnutrition, dehydration, health & safety hazards)
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why was the Lanterman-Petris-Short Act passed?
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(in 1967) to end the inappropriate, indefinite and involuntary commitment of mentally disabled, developmentally disabled and chronic alcoholics
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What is the basic idea of the LPS Act?
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Clients keep their basic rights unless danger to self or others, or gravely disabled (can't provide for food, clothing and shelter for self).
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Which psychologists have 5150 privileges?
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Must have hospital privileges
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how long is a 5150 hold?
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72 hours (i.e., 3 days)
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What happens after the 5150 expires and adult is still a danger/gravely disabled?
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5250 hold - lasts for 14 days
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What happens after 5250 expires and adult is still a danger to self/danger to others/gravely disabled?
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Must have a probable cause hearing within 4 days of expiration of the 5250, to see if need to be held. If suicidal, recertified for add'l 14 days (section 5260). If gravely disabled, up to 30 add'l days (section 5270). Can also be conserved and released (section 5350). If danger to others can be postcertified for 180 days (section 5300).
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4 possibilities
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If adult loses 5250 hearing for probable cause, are there any remedies?
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Ct can file habeas corpus to be reviewed by superior court
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What happens if the probable cause (after 17 days) hearing shows adult is still dangerous to self?
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Can get additional 14 day postcertification.
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What happens if adult is still dangerous to self after 31 days?
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Person is released, unless renewed by the court
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What happens if probable cause hearing (after 17 days)shows that the adult is still dangerous to others?
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Court can give 180 day post certification, which can be renewed
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Why are adults placed on LPS conservatorship?
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If the court determines they are gravely disabled, they are placed on 30 day temporary conservatorship, which can be followed by a 1-year conservatorship that is renewable annually.
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What are the rights of a child under age 14 regarding involuntary hospitalization?
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parents can do it, and the child has no right to a hearing
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What are the rights of a child age 14 regarding involuntary hospitalization?
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Child has a right to a hearing to determine if there is probably cause that youth needs treatment.
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George has been involuntarily hospitalized. His MD gives him an atypical antipsychotic which he says makes him too sleepy. He doesn't want to take it. Can he refuse it? Can the MD insist he take something else w/similar effects?
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he can refuse it under any circumstances, as long as there isn't an emergency, and he isn't in immediate danger of harming himself or others.
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A client was admitted on a 5150, acutely psychotic from an inadvertant overdose that also caused great joint pain. When briefly unconscious she was given morphine for the pain that was then continued for 24 hours until the joint problem abated. The medication rendered her only semi-conscious during that time. After her discharge, she sued the hospital for involuntarily administering medication. What happened in court?
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She lost. There was no evidence that the patient would refuse the medically indicated treatment to control her pain.
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What are 6 reasons you can treat a minor without parental consent?
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If minor is legally emancipated, or
If minor is self-sufficient, or If tx is related to pregnancy or pregnancy prevention, or If clt has been the victim of a sexual assault, or if minor presents danger of harm to self or others, or if minor is alleged victim of incest or child abuse. MINOR MUST BE mature enough to participate intelligently in treatment. |
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What is the youngest age at which a court will declare a minor emancipated? What 2 other conditions must be met?
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If at least 14, living separate from parents with their consent, and if managing own finances with income that is not from criminal activity
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When is a minor considered self-sufficient?
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If 15 or older, if living separate form parent with or without consent, AND if managing own finances no matter what the source of income.
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All children can be treated without consent for some types of issues. What additional areas can children 12 or over be treated for without consent of parents?
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communicable diseases (tho this is likely by an MD), or
tx for substance abuse (tho psychologist should try to include guardians if appropriate) |
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In addition to all the other reasons listed for treating minors without consent of parents, what does the Family code add about parents and treatment?
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don't need to include parents if it is inappropriate. Need to document why guardian should not be contacted, or if attempts were made but guardian did not respond.
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Jane, a legally self-sufficient 16 year old, attends therapy sessions without the participation of her parents. Who pays for the sessions?
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She does. Parents are only liable for payment if they participate.
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Joe, a minor, consents to his own treatment and pays for it. He is 16. Can he consent to the release of his MH records?
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yes. If you consent on your own as a minor, you can consent to release of records.
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what is the time frame for making a CPS report?
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Call immediately, or as soon as is practicably possible. Prepare and send the form within 36 hours of receiving the information.
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According to CA law (section 2919 of CA Business and Professions Code), how long do psychologists keep health records?
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adults: 7 years from discharge date.
minors: 7 years from the date the ct reaches age 18 |
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When can FERPA records be released without written permission?
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-health and safety emergencies
-to comply with court -to school officials with a legitimate interest -to accrediting agencies and other specified parties -to schools to which student is transferring -to parties connected to financial aid |
6 different conditions
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Psychologist Susie sees her 36 year old married client, who discloses that she has been physically abused by her husband, and shows Susie the bruises on her arms and back. Does Susie need to make a Suspicious Injury Report under California’s Domestic Violence & Mandatory Reporting Law?
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no. she is not providing medical services for a physical condition. However, she should counsel her client about resources for abused spouses, make an emergency/exit plan, and power-control issues.
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Can the FBI require disclosure of PHI under the Patriot Act?
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yes, unbelieveable but true
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When can convulsive tx be performed on minors?
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Under 12 - never
12 through 15 - in an emergency when needed to save his life, when approved by 3 child psychiatrists and all other regular consent procedures are followed 16 and 17 years - can exercise rights as if an adult "No convulsive tx shall be performed if the px ... is deemed able to give informed consent and refuses to do so." |
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Describe some of the rights of patients under LPS, when involuntarily confined.
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wear own clothes, use own possessions, spend reasonable sum of own money, access to storage space, access to phone for confidential calls, access to writing materials including stamps, right to refuse convulsive tx, right to refuse psychosurgery, get services form a patient advocate, right to religious freedom and all other typical rights guaranteed by the US Constitution and State of CA
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How soon must a requested judicial review of a 14 day hold (5250) occur?
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4 days
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After a 5250, how long is the next hold?
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30 days according to 5270, subject to a certification review, for grave disability or 14 days for suicidality, (5260) with certification review or 180 days for harm to others (section 5300)(also have right to jury trial if disagree w/cert review)
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At what point in an involuntary commitment does a px have the right to a free lawyer (if unable to pay) and qualified interpreter and hearing before a judge
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If held longer than 72 hours.
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According to the Business and Professions Code of CA, how long does an adult have to file any accusation (not including sexual misconduct) against a licensee? What if a minor is involved?
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7 years from the date the alleged act or omission occurs (according to law excerpts given by Dr. Taube). If a minor is involved, 7 years after the minor reaches "the age of majority."
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According to the Business and Professions Code of CA, how long does an adult have to file an accusation involving sexual misconduct against a licensee? What if a minor is involved?
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Ten years, and if it is w/a minor, 10 years after the "age of majority."
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what is the time period for reporting elder/dependent adult abuse?
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by phone immediately or as soon as possible, and by written reporty within two working days
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What types of abuse are listed as specifically reportable for elders/dependent adults, in addition to the types reportable for children?
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financial abuse, isolation, misuse of medication, abduction, abandonment
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an 11 year old may consent to medical care and counseling relating to the dx and tx of a drug- or alcohol-related problem. true or false? Should the treatment plan involve the minor's parents?
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false. minor must be 12 or older. Any minor's parents should be involved, "if appropriate as determined by the professional person" or document the reason why not appropriate to contact parents.
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When is there no privilege for patients under the age of 16?
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The psychotherapist has reasonable cause to believe that the patient has been the victim of a crime and that disclosure of the communication is in the best interest of the child.
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what does Cyrus Psychologist do if he becomes aware from his patient that she had sexual contact with a previous therapist?
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provide her with the "Therapy never includes sex" brochure and discuss its contents with her (failure to do this is "unprofessional conduct"). Encourage her to report it if she wants. Help her to do so.
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What is the exception to the APA Code not applying to the purely private conduct of psychologists?
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"the APA may take action against a member after his or her conviction of a femony whether or not it directly resulted from activities performed in role as psychologist" (Fisher p 12)
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What actions can the Ethics Committee take against members?
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Dismiss the case; or reprimand (violation not likely to cause harm to another or the profession), censure (could cause some but not substantial harm), expulsion (substantial harm or sufficient gravity to warrant the action), stipulated resignation. Can also ask person to case and desist an activity, to obtain supervision or additional training or education, be evaluated for and obtain treatment if appropriate, or agree to probationary monitoring
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What are the parts of the APA Ethics code? Which part includes enforceable rules? Which part is the basis for civil liability?
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Preamble and General Principles give aspirational goals. the Ethical Standards give enforceable rules. No part is basis for civil liability.
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What happens if Ethical Code and state or local laws are in conflict?
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If Ethical Code gives higher standard of conduct, must meet it. If conflicts with law, must make known commitment to Ethics Code and take steps to resolve the conflict in a responsible manner. If can't resolve it, can adhere to law, in keeping with basic principles of human rights (however this latter obligation does not appear in the relevant enforceable standard).
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What are the General Principles, and in what order are they listed?
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A- Beneficence and nonmaleficence
B - Fidelity and Responsibility C- Integrity D - Justice E - Respect for People's Rights and Dignity They are listed alphabetically. They are NOT hierarchically organized. |
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When can teaching psychologists require students or supervisees to disclose personal information regarding sexual history, hx of child abuse/neglect, psychological tx, or relationships?
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- it was clearly identified in the program description, OR
- the info is necessary to help a student or protect others from harm |
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In which two types of circumstances does HIPAA NOT require release of records to clients/patients?
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When info is compiled in reasonable anticipation of, or for use in, civil, criminal, or administrative actions or proceedings (Fisher p 29). Also if release of PHI is reasonably likely to endange the life or physical safety of the individual or another person, or islikely to cause equally substantial harm. (fisher p 97)
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When are psychologists not obligated to protect test material security?
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When the materials include client/patient responses, the psychologist's contemporaneous notes regarding test performance, or individually identifiable information (fisher p 29)
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What does a psychologist do if s/he is in an unavoidable or unexpected multiple relationship?
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If unavoidable (i.e., small community, qualified to provide unique services not otherwise available, etc.): take reasonable steps to protect objectivity and effectiveness and to avoid possible exploitation and harm by phone consultations, extra steps to protect confidentiality, explaining risks of multiple relationships and steps s/he will take to avoid them, etc.
- if unforseen: take reasonable steps to resolve it with due regard for the best interests of the affected person and maximal compliance iwth the Ethics code (ex: neighbor begins dating your client. Client likely to find out situation. Can't avoid neighbor. Consult w/colleague. Might need to explain situation to client, provide a referral and assist transition during termination counseling). |
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A 12 year old child's parents consent to tx for his depression. The child does not want to participate. What does the psychologist do?
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The psychologist is supposed to "respect a person's right to dissent from participation" but "this right can be superceded if the failure to participate would deprive persons of psychological services necessary to protect or promote their welfare." (Fisher p 78).
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What is FERPA?
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The Family Educational Rights and Privacy Act, a federal law, that protects the privacy of student education records inall schools that receive funds under an applicable program of hte US Dept of Ed. FERPA gives certain rights to the parents that transfer to the student at age 18 or beyond high school. Educational records may not be released without written consent except in specific circumstances (see other FERPA question).
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If using Internet/electronic transmission in tx, what additional info must psychologist give to clients?
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the risks to privacy and limits of confidentiality that are increased due to this type of exchange (i.e., hackers, possibility that other staff have access to info, people accessing cell phone calls a la Prince Charles)
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During a break in an assessment battery for a competency determination of an incarcerated young man, the forensic psychologist heard the manbrag about the crime to anotehr inmate. During the competency hearing, the psychologist's expert testimony included mention of hte casual admission to the crime. Was this ethical?
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no. Standard 4.04: Psychologists include in written and oral reports and consultations, only information germane to the prupose for which the communication is made. (Fisher p 94)
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The Board of Psychology can suspend a psychologist's license or issue it contingent on various terms and conditions if the psychologist has been convicted of drunken driving on the way home from a friend's party. True or false?
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True. SEction 2960 of the Business and Professions Code states that unprofessional conduct can include Use of any alcoholic beverage to an extent or in amanner dangerous to himself or herself, any other person, or the public. It does not need to impair his or her ability to perform as a psychologist.
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Can a current therapy client/patient provide a psychologist with an unsolicited testimonial that the psychologist can then in an ad?
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yes. Psychologists can't solicit testimonials from current patients, or other persons who might be "vulnerable to undue influence" such as parents of kids with LDs who depend on the PhD to qualify their child for special ed services.
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Some psychologists may have contracts with HMOs that provide financial incentives to limit the number of sessions, such as capitated agreements. Generally, such arrangements must be disclosed as part of informed consent procedures. T or F?
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True
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Susie Famous Person joined an adult therapy group. At the first meeting the psychologist described the roles and responsibilities of all parties and applicable confidentiality. Later, another group member leaked to the press information about a sexual relationship that Susie had discussed in the group. Susie sued the psychologist and the group member for the disclosure. What happened in court?
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Assuming that the psychologist discussed the limits of confidentiality appropriately, nothing. "At the outset of group therapy, and each time a new member enters an ongoing group, psychologists must take reasonable steps to clarify that they can request, but not guarantee, that all group members maintain the confidentiality of statements made during sessions." (FIsher p 222)
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David was in therapy with Peter Psychologist for a year. One day, David disclosed that his boyfriend had recently bought a gun with which he intended to threaten the psychologist, because David seemed to be about to leave him. David suggested that the therapist might want to hire a guard for the waiting room. Dr. P immediately terminated David's therapy, in that session, and informed the police of the boyfriend's actions. David sued Dr. P for malpractice. Who won?
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Dr. P.
Standard 10.10b: Psychologists may terminate therapy when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship. (See Fisher p 233) |
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